Intravascular Large B-Cell Lymphoma After Kidney Transplantation: A Rare Form of Post-Transplant Lymphoproliferative Disorder.
Takeshi Aoyagi, Rei Matsui, Yutaka Imamura et al.
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Case in brief
A Japanese man in his 60s developed intravascular large B-cell lymphoma (IVLBCL) 4.5 years after kidney transplantation, presenting with general fatigue and loss of appetite. Laboratory tests showed anemia, hypoalbuminemia, and hyponatremia, while imaging studies were unremarkable. A skin biopsy revealed CD20-positive atypical lymphocytes in vessel lumina, confirming IVLBCL. Despite R-CHOP therapy, he succumbed to multiorgan failure 31 days post-admission.
What made this case unusual
The case highlights the occurrence of IVLBCL after kidney transplantation, a rare form of post-transplant lymphoproliferative disorder that can mimic other conditions like thrombotic microangiopathy.
Diagnostic / clinical pearl
Clinicians should consider IVLBCL in post-transplant patients presenting with cytopenia and systemic symptoms, even when imaging is negative, to avoid delayed diagnosis and fatal outcomes.
Why it matters
Recognizing IVLBCL as a differential diagnosis in post-transplant patients is crucial, as its clinical presentation can easily be mistaken for more common conditions, impacting timely management.